Rohrich Rachel N, Li Karen R, Episalla Nicole C, Atkinson Khaleel, Lin Ryan P, Ferdousian Sami, Youn Richard C, Evans Karen K, Akbari Cameron M, Attinger Christopher E
Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, 3800 Reservoir Road, NW, Washington, DC 20007, USA.
Georgetown University School of Medicine, Washington, DC 20007, USA.
J Clin Med. 2025 Jan 17;14(2):596. doi: 10.3390/jcm14020596.
: Medial arterial calcification (MAC), a distinct form of vascular pathology frequently coexisting with peripheral arterial disease (PAD), poses unique challenges in limb salvage among patients with diabetes, chronic kidney disease, and end-stage renal disease. This study examines the incidence of MAC and its impact on limb salvage outcomes over a decade of experience at a tertiary limb salvage center. : A retrospective review of all complex lower extremity (LE) reconstructions using local flap (LF) or free tissue transfer (FTT), performed from July 2011 to September 2022, was conducted. Patients were classified into MAC and No MAC groups based on pedal radiography evaluations using the Ferraresi MAC scoring system. The primary outcomes were major lower extremity amputation (MLEA), the need for postoperative vascular intervention, major adverse limb events (MALE; defined as the composite of any unplanned reoperation, MLEA, or postoperative revascularization attempt), and mortality. : During the study period, a total of 430 LE reconstructions were performed with LF or FTT. A total of 323 cases (75.1%) demonstrated no MAC while the remaining 107 (24.9%) demonstrated MAC. The MAC group exhibited significantly higher rates of diabetes, PAD, and renal disease. With a follow-up duration of 17.0 (IQR: 33.9) months, the MAC group demonstrated a significantly higher rate of MLEA (24.3% vs. 13.0%, = 0.006), postoperative vascular intervention (23.4% vs. 8.7%, < 0.001), MALE (57.0% vs. 25.7%, < 0.001), and mortality (28.0% vs. 9.9%, < 0.001). Multivariate analysis identified MAC as independently predictive of MALE (OR: 1.8, CI: 1.1-3.0, = 0.033). : MAC is prevalent among surgical candidates for limb salvage. Patients with MAC represent a significant medical and reconstructive challenge. Radiographic screening for MAC should be considered in all limb salvage candidates with LE wounds, especially in those with diabetes and kidney disease. Assessing MAC is important for better evaluating risk factors and surgical options so as to optimize outcomes in this challenging population.
: 内侧动脉钙化（MAC）是一种独特的血管病变形式，常与外周动脉疾病（PAD）并存，给糖尿病、慢性肾病和终末期肾病患者的肢体挽救带来了独特挑战。本研究通过一家三级肢体挽救中心十年的经验，考察了MAC的发生率及其对肢体挽救结果的影响。: 对2011年7月至2022年9月期间使用局部皮瓣（LF）或游离组织移植（FTT）进行的所有复杂下肢（LE）重建手术进行了回顾性研究。根据使用费拉雷西MAC评分系统的足部X线评估，将患者分为MAC组和非MAC组。主要结局指标为大下肢截肢（MLEA）、术后血管介入需求、严重肢体不良事件（MALE；定义为任何计划外再次手术、MLEA或术后血管重建尝试的综合情况）和死亡率。: 在研究期间，共进行了430例LF或FTT的LE重建手术。共有323例（75.1%）未出现MAC，其余107例（24.9%）出现MAC。MAC组的糖尿病、PAD和肾病发生率显著更高。随访时间为17.0（四分位间距：33.9）个月，MAC组的MLEA发生率显著更高（24.3%对13.0%，P = 0.006）、术后血管介入率（23.4%对8.7%，P < 0.001）、MALE发生率（57.0%对25.7%，P < 0.001）和死亡率（28.0%对9.9%，P < 0.001）。多因素分析确定MAC是MALE的独立预测因素（比值比：1.8，置信区间：1.1 - 3.0，P = 0.033）。: MAC在肢体挽救手术候选者中很常见。MAC患者代表了重大的医学和重建挑战。对于所有有LE伤口的肢体挽救候选者，尤其是糖尿病和肾病患者，应考虑进行MAC的影像学筛查。评估MAC对于更好地评估危险因素和手术选择以优化这一具有挑战性人群的结局很重要。
